BACKGROUND The management of ipsilateral femoral shaft fractures after hemiarthroplasty is controversial. METHODS Fifteen patients (average age 82.4 +/- 8 years) with ipsilateral femoral shaft fractures after uncemented hemiarthroplasty were treated by closed reduction and Ender nailing. Under radiographic control, closed reduction was attempted. If not possible, cerclage of the shaft fracture was accomplished through a limited lateral approach. Ender nails were then inserted well past the tip of the stem of the prosthesis. RESULTS There were a superficial wound infection and a deep vein thrombosis. At 6 months, five patients had died, and backing out of the nails necessitated removal in one patient. At 1 year, nine patients were still alive. Of these, seven were able to walk with aids. At 2 years, seven patients were still alive and were walking with aids. Two patients presented shortening of more than 1.5 cm of the operated femur. After an average of 5 years, 11 patients were dead, two were still walking, and two were bedridden. CONCLUSIONS The technique described is an option in the treatment of fractures of the ipsilateral femoral shaft after uncemented hemiarthroplasty.